Clinical Content Specialist (Payment Integrity - Drugs & Biological)

This role is not for 2070 Health.

About CoverSelf:

CoverSelf empowers US healthcare payers with a truly next-generation, cloud-native, holistic, and customizable platform designed to prevent and adapt to the ever-evolving inaccuracies in healthcare claims and payments. By reducing complexity and administrative costs, we offer a unified, healthcare-dedicated platform backed by top VCs like BeeNext, 3One4 Capital, and Z21 Ventures.

Position Overview:

The Clinical Content Specialist – Pharmacy will be responsible for developing and validating high-quality content related to Drugs & Biologicals (D&B) within the US healthcare domain. The role focuses on ensuring accuracy, compliance, and clinical relevance of concepts that impact high-cost medical spend areas such as chemotherapy and specialty drugs. This position requires strong expertise in pharmacy, clinical interpretation, and healthcare coding to support payment integrity and reduce inaccurate reimbursements.

Requires a deep understanding of Pharmacy, Clinical aspects

Pharmacy Aspects

Good understanding of Drugs and Biologicals and their classification

Awareness of Pharmacy regulatory bodies, like CDSCO,DCGI,DoP

Generic and Brand drugs awareness

Dosage determination, medical necessity, safety and compliance.

Clinical Aspects

Dosage and Administration

Medical Necessity

Frequency of Medication

Contraindication

Age/Gender

Adverse Drug Reaction

Off label usage

Good understanding of US Healthcare insurance Domain:

Medical coding and reimbursement guidelines of US healthcare.

NDC, HCPCS (J-codes), CPT, ICD, Modifiers, Revenue codes, etc.

CMS, Medicaid guidelines, and payer policies.

Understanding of CoverSelf Policies and Sub-Policies

Research and ideation of concepts based on CoverSelf Policies and Medical and pharmacy literatures and drug labels

Understanding of Medical and Pharmacy Literatures

Familiarity of Drug Labels, FDA, Well-known Medical journals (Pub-Med, NCBI), CMS, Medicaid guidelines

Ability to read and Interpret complex of medical and pharmacy literatures

Extract Rule logic based on CS policies

Correlation of multiple literatures to arrive at conclusion

Passionate about working in the pharmacy and clinical domain, with a focus on learning and growth

Should be passionate about pharmacy and the clinical side

Strong foundation in pharmacy and clinical concepts, including drugs and biologics

Demonstrated experience in research work, college thesis, or complex case study analysis

Strong research mindset with the ability to interpret clinical and medical literature

Excellent communication, articulation, and interpretation skills

Ability to translate complex clinical information into clear and structured insights

Sound clinical knowledge with attention to detail and accuracy

Educational Qualifications:

Pharm.D (Doctor of Pharmacy) – Preferred (Priority)

M.Pharm – Pharmacology / Clinical Pharmacy

Certification Requirements:

CPC or COC certification – highly preferred

Freshers with a strong foundation in Pharmacy/Clinical concepts and a research mindset can be considered.

Work Details:

Location: Jayanagar, Bangalore

Mode: Work from Office

Best-in-class compensation

Health insurance for Family

Personal Accident Insurance

Friendly and Flexible Leave Policy

Certification and Course Reimbursement

Medical Coding CEUs and Membership Renewals

Health checkup

And many more!